Friday, October 1, 2010

Yabba Dabba Doo! (And health care too)!

Like most kids who grew up in the 1960s, I spent many a night watching the adventures of Fred, Wilma, Barney and Betty, the coolest cavemen ever (sorry, GEICO). It is hard to explain the appeal of the Flintstones, which yesterday celebrated the 50th anniversary of its first broadcast. Its animation was primitive, the stories campy and cliché, and it was horribly sexist - but the characters were lovable, the dialogue funny, and who could not love the way it depicted "modern conveniences" (like washing machines) using only stone-age technologies (bones, stones and dino-power)?

What does Fred Flintstone have to do with health care? Not much, really, although Fred was the victim of a medical error. According to answers.com, "A 1966 episode had Fred can't stop sneezing, so he goes to the doctor for some allergy pills. The prescription gets mixed up with another package of pills which, when taken, transform Fred into an ape! Only Barney witnesses this metamorphosis, and naturally he can't convince anyone what is happening ... until a fateful family outing at the Bedrock Zoo." (Of course, this all might have been prevented if they had e-prescribing in those days.)

But the Flintstones weren't the only cartoon to make the news yesterday; a new one came out to explain health care reform. No, it wasn't a case where Fred decided to pull an Andy Griffith and endorse health care reform (despite his unfortunate encounter with the health care system) since Fred is way too media-savvy to risk his popularity! Instead, it is "YouToons" characters explaining the Affordable Care Act in a 10 minute animated film, Health Reform Hits Main Street, released by the Kaiser Family Foundation. It is the best, most entertaining, and balanced explanation of the law I have seen, and I highly recommend it to anyone who is confused about the Affordable Care Act (and who isn't?).

Today's questions: Did you watch the Flinstones, and if you did, what was your favorite episode? What do you think of the new animated film on the Affordable Care Act?

8 comments
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I have to say, I am speechless. Trivialization of the gravity of this issue and another suggestion if we just watch a cartoon we would "be all for it". Respectfully, don't you really need to change the name of this blog.I mean really, what is the definition of "acp advocate blog" mean to you. Perhaps we could have comments from readers about issues that members what to see addressed in THEIR advocate/ethics blog

Please spend some genuine time for introspection, Mr. Doherty about where you want this blog to go.

Well, about what you would expect from a cartoon by a huge managed healthcare company, and narrated by Cokie Roberts, the ultimate political insider. Pay special attention to the scene in which the doctor scurries between patients while Uncle Sam and the insurance man check a stopwatch. Pretty much defines our role in the new healthcare system. Thanks for the insight. What can ACP's advocates do to stop Uncle Sam and the insurance man from cheapening the physician-patient relationship to this level? Does the ACP leadership even think this is a problem?Ironically, I received an email soliciting money yesterday from ACP Services PAC, to which (as the email informed me) all ACP members automatically belong. Prominently displayed: "Dedicated to protecting the interests of internists and their patients". I guess that sounds better than "Grinning foolishly as our members are led to slaughter", after ACP leaders supported the ACA and published an article by Obama insiders in the Annals. Sometimes you just have to chuckle as you hit the delete button.

The issues are serious, but I think from time to time it is good to introduce a little humor into the conversation, as I tried to do with the Fred Flinstone references. Obviously, people differ on what they find funny . . .

I do need to correct the facts on several points made in the other comments.

--The cartoon that explains the health care reform law was not produced by an HMO or insurance company. It was produced by the Kaiser Family Foundation, a non-profit, non-partisan charitable foundation that has no relationship with the Kaiser-Permanente medical group. It is an extraordinarily well-respected foundation. You can learn more about it at http://www.kff.org/.

I had the opportunity to show the cartoon this weekend to ACP members who serve on our principal policy committees, the Health and Public Policy Committee and Medical Service Committee. The members of the committees uniformly felt that it was entertaining, accurate, and balanced, presenting the issues in a way that would be understandable to much of the public. (The cartoon doesn't just present the popular parts of the law, but also explains elements that are less popular, such as the higher taxes that will be imposed on some people). Given that polls show that much of the public remains confused about the law and large percentages get basic factual issues wrong, I think there is value in making readers of this blog aware of resources to explain the law in simple and accurate language. I am under no illusion though that a cartoon--or other information sources, for that matter--no matter how respected the source, will change the minds of those who are opposed to the law on philosophical, ideological or partisan grounds, but for the many Americans who are unsure what it is all about, there is value in pointing them to reputable and non-partisan sources of accurate information.

--On ACP Services, it is true that all ACP members are members of ACP Services, Inc, but they are not members of the ACP Services Political Action Committee unless they voluntarily choose to contribout to the PAC. ACP Services supports a wide range of advocacy effforts for its members, including its grass roots key congressional contact network, Leadership Day on Capitol Hill, and legislative representation with Congress. ACP Services was created because as a 501-C-6 corporation, it is not subject to limits on lobbying expenditures that ACP, a 501-C-3 charitable organization, is subject to. But the PAC operated by ACP Services is completely independent of ACP's charitable arm, and ACP members who automatically belong to ACP Services do not automatically belong to the PAC--it is totally up to each member to decide whether they wish to contribute to an join the ACP Services PAC or not.

--The Annals of Internal Medicine has complete editorial independent from ACP governance and leadership. This relationship, and the reasons why the editor of Annals chose to publish a perspectives piece from Obama administration officials, is fully explained on the Annals website,

(Especially see the comments from Christine Laine, the editor of Annals, and from Robin Luke, the chair of ACP's Board of Regents).

Finally, I understand that this blog is not everyone's cup of tea, but I will continue to comment on issues that I think are important to health care delivery and ACP members, such as my recent posts on the value of primary care, medical liability reform, Dr. Berwick's views, public attitudes' and understanding of health reform, and physician-industry relationships. And, as always, I welcome alternative points of view from ACP members and non-member readers alike. It is because I take your comments seriously that I felt the need to respond in detail to the concerns expressed by the previous two posted comments.

I found the animated film on the ACA by the Kaiser Family Foundation rather entertaining and a good way to explain the complicated legislation. How the dermatologists got a tax on sun tanning beds through is rather amazing. Of all the sins to tax, sun bathing is not one high on the list. Then again, sun tanning salons just don't have the lobbying power as the tobacco industry.

Yes, Bob, having some humor interjected is a good thing. My physician model Sir William Olser was quite the prankster in his day and he understood the importance of a laugh.

I agree with Linda's feelings. This is certainly a "funny" way of explaining how the new law will kill Internists in small practices as it is implemented. I still cannot understand the "wisdom" of the ACP's actions in supporting this ugly law.

Would an injury to Fred's feet be covered under the new health care reform act, or would he be caught in the middle between the health insurance carrier and the car insurance carrier?Or would it be covered under a warranty as an integral part of the car?

I always wanted to have a brontosaurus burger, probably with fries and a coke, when i was a kid watching fred and barney, et al.

Most people, most doctors for that matter, don't know the salient points of the ACA and their timeline for implementation.People, whether they be our patients, our families, or our colleagues, have different means/techniques of learning. I found this to be especially true in my med school classmates.

Some learn by memorizing text, some by visual imagery, some by learning bits of information piecemeal over time, some by listening to audio presentations. I liked this video, found it to be surprisingly salient, and entertaining enough to keep me interested. I especially enjoyed the depiction of the "high-risk pool".

I think some persons would do well to learn the important aspects of the ACA with the 5 pg handout developed by AARP/ACP. Others may be better served by this video, based on the way they learn.

I am sorry, I can't just accept Mr. Doherty's suggestion to find out about the Kaiser Family Foundation from their website. A little digging reveals that the KFF was founded in 1948 by Henry Kaiser, who also established Kaiser Permanente. At his death half of his estate went to the KFF, and well into the 80's, KFF had large financial interests in various Kaiser industries. There has always been a member of the Kaiser family on the corporate health plan/hospitals Board, as well as a family member serving as a Kaiser Family Foundation Trustee. So is there influence? And while there are journalists, politicians, academics, and business people as KFF Trustees, there is (curiously) no one from any patient or physician organization. So the point remains, even a respected organization operates from a certain viewpoint, and that viewpoint shows the physician-patient relationship merely as a cost center to be tweaked.

As far as the Annals article "The Affordable Care Act and the Future of Clinical Medicine: The Opportunities and Challenges", the ACP leadership can't back out of responsibility that easily. Didn't the ACP board appoint Dr. Laine? Does she answer to ACP for the quality and fairness of articles in the Annals? There are between 3 and 5 editorials in every Annals, responding to an original article, often offering a counterpoint or broader view on the issue. Could Dr. Laine find no commenter? She could have looked no further than Dr. Ralston, the ACP President, who wrote a response stating he disagreed with aspects of the article. Poor editorship or biased editorship?

But I am the most concerned that the members of the ACP Health and Public Policy Committee thought the cartoon was "entertaining, accurate, and balanced". I guess they won't be as amused when a real version of Uncle Sam stands outside their exam room with a stopwatch.